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目的探讨微创经皮肾镜取石术(MPCNL)治疗重复肾输尿管结石的临床应用价值。方法采用B超定位下MPCNL治疗30例重复肾、输尿管结石患者。男性12例,女性18例。平均年龄38(18～66)岁。30例均由静脉尿路造影及CT确诊。上位肾结石4例、下位肾结石19例(其中鹿角形结石6例)、输尿管交汇处结石7例。结石平均直径3.4(2.5～4.7)cm。结果30例均成功建立经皮肾通道,平均手术时间70(30～120)min。术中平均出血30(5～60)ml,均未输血。结石一期清除率90%(27/30),3例有少许残石者1月后行体外冲击波碎石(ESWL)后结石排净。术后无继发出血、无发热。随访12～24个月,结石无复发。结论MPCNL治疗重复肾结石具有手术时间短、出血少、结石清除率高、术后并发症少等优点,安全有效。
Objective To investigate the clinical value of minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of recurrent renal ureteral calculi. Methods Thirty patients with recurrent renal and ureteral calculi underwent B-mode ultrasonography with MPCNL. 12 males and 18 females. The average age of 38 (18 ~ 66) years old. 30 cases were diagnosed by intravenous urography and CT. 4 cases of upper kidney stones, 19 cases of lower kidney stones (including 6 cases of deer horns stone), ureteral junction stones in 7 cases. The average diameter of stones 3.4 (2.5 ~ 4.7) cm. Results All 30 cases were successfully established percutaneous renal access, the average operation time 70 (30 ~ 120) min. Average intraoperative bleeding 30 (5 ~ 60) ml, no blood transfusion. The first stage stone removal rate was 90% (27/30), and in 3 cases, a few residual stone stones were discharged after ESWL in January. No secondary bleeding after surgery, no fever. Follow-up 12 to 24 months, no recurrence of stones. Conclusion MPCNL has the advantages of short operation time, less bleeding, high stone clearance rate and less postoperative complications, which is safe and effective.